Insulinoma presenting with cardiac arrest and cardiomyopathy

Arthi Thirumalai, Ximena Levander, Somnath Mookherjee, Andrew A. White

Research output: Contribution to journalArticle

Abstract

A 33-year-old woman presented with ventricular fibrillation cardiac arrest and was found to have a blood glucose of 1.83 mmol/L. Cardiac catheterisation revealed a dilated left ventricle with an ejection fraction (EF) of 26% and angiographically normal coronary arteries. Continuous dextrose infusion was required to treat hypoglycaemia, which prompted consideration of insulinoma as a possible cause for her cardiomyopathy. Whipple 's triad was demonstrated; a 72 h fast provided biochemical evidence of insulinoma, and imaging localised a tumour in her pancreas. The tumour was resected and pathology confirmed insulinoma; pancreaticoduodenectomy cured her hypoglycaemia. No alternate cause of cardiomyopathy was found and 4 months after surgery her EF improved to 41%. High insulin levels can close cardiac KATP channels associated with dilated cardiomyopathy; the catecholamine surge from hypoglycaemia may also contribute to ventricular remodelling. Hypoglycaemia can cause QT segment prolongation, and may have precipitated fibrillation in this patient's arrhythmia-prone myocardium.

Original languageEnglish (US)
JournalBMJ Case Reports
DOIs
StatePublished - Oct 23 2013
Externally publishedYes

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Insulinoma
Heart Arrest
Cardiomyopathies
Hypoglycemia
KATP Channels
Ventricular Remodeling
Pancreaticoduodenectomy
Dilated Cardiomyopathy
Ventricular Fibrillation
Cardiac Catheterization
Heart Ventricles
Catecholamines
Blood Glucose
Cardiac Arrhythmias
Pancreas
Neoplasms
Coronary Vessels
Myocardium
Insulin
Pathology

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Insulinoma presenting with cardiac arrest and cardiomyopathy. / Thirumalai, Arthi; Levander, Ximena; Mookherjee, Somnath; White, Andrew A.

In: BMJ Case Reports, 23.10.2013.

Research output: Contribution to journalArticle

Thirumalai, Arthi ; Levander, Ximena ; Mookherjee, Somnath ; White, Andrew A. / Insulinoma presenting with cardiac arrest and cardiomyopathy. In: BMJ Case Reports. 2013.
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